3D modeling in the planning of treatment of femoral tumors

Background. The outcome of surgical treatment of fe-moral tumors (FT) depends on the knowledge of the real picture of the extent of bone and soft tissue damage. The objective picture of the lesion can be significantly supplemented by virtual modeling in the framework of MRI, CT, and 3D modeling of the process, which is practically not studied in Ukraine. Real solid modeling of a skeletal segment with a tumor can produce the most optimal volume of resection and structure formation for stable fixation of bone fragments. The purpose of the work is to improve the technique of 3D modeling of hip tumors for preoperative planning of surgical intervention and the development of the most optimal design of the device. Materials and methods. The available literature data were analyzed; the radiographs, case histories of 15 patients with FT were studied. Good results of treatment of the last are possible at thorough preoperative planning. Results. We use technologies of 3D modeling and 3D printing of solid models of FT. This allows planning the line of the proposed bone resection, to properly form a graft from bioactive ceramics, tutoplast or own bones. 3D modeling helps to create the most optimal design of the device, which provides stable fixation of these grafts to the femoral fragments. The length of resection of the tumor segment with the tumor was calculated using multidetector compu-ted tomography (MDC) perfusion. This makes it possible to conduct preoperative training to establish the structures of the formed fixators on the segment of bone fragments — graft (BFG), to determine its bearing capacity. Based on planning and preoperative training, 5 ope-rations were performed on the hip. To stabilize the BFG segment, optimized constructions based on a DHS-type clamp, LCP-plates, or a clamp for low-contact multiplane osteosynthesis were used. Conclusions. Application of the technology of 3D modeling and 3D printing of solid models of specific SC and tumors allow planning the line of the proposed bone resection. Based on this, you can form the size of the graft, create a fixator structure that provides stability in the BFG. The preoperative training facilitates surgery. All this helps to choose the most optimal treatment tactics.

Psychosocial Implications of Patients with Tracheostomy - a Suggestive Example of Interdisciplinarity

Performed urgently or out of necessity, tracheostomy is one of the most traumatic surgeries that seriously affects the patient's quality of life. It has a profound impact on the ability to communicate and on self-esteem, so that the patient can experience a storm of emotions and major changes that can affect their existence. The patient with tracheostomy is a special patient with special needs. The care of such a patient involves a constant multidisciplinary effort supported by specialists in many fields: ENT specialists, oncologists, radiotherapists, anesthetists, neurosurgeons, general surgeons, physiotherapists, speech therapists, nutritionists especially psychotherapists. Tracheostomy affects the basic needs of the individual: communication, nutrition, sexuality, social relationships. Numerous studies show that patients with tracheostomy show a high level of psychological distress. Depression, anxiety, low self-esteem, frustration, alienation, isolation, tendency to suicide are the negative consequences of this mutilating surgery. Perceived as a permanent disability, tracheostomy requires special care from a psychological point of view. Sometimes, however, it is observed that both patients and their families are not sufficiently informed about the management of tracheostomy. Due to lack of means or staff, not enough emphasis is placed on preoperative training so that the patient fully understands both the benefits and the disadvantages of this surgical technique. Therefore, often the patient's family, which later assumes the role of caregivers of the tracheotomized, perceives it as a burden, excessive fatigue, helplessness, abandonment from society. This paper aims to highlight the importance of pre- and postoperative psychological training of both the patient and his family and to demonstrate that tracheostomy care can be one of the most suggestive examples of interdisciplinarity that seeks to provide effective solutions in this regard.

Impact of preoperative education on ostomy patients quality of life

Human well-being is directly related to his health. Preoperative training of patients and selection of the optimal stoma location are probably the most important factors influencing the postoperative quality of life of stoma patients. Study aim - to determine the impact of preoperative training on the quality of life of stoma patients. Study methods. The analysis of the scientific literature and quantitative research was used for the survey, which was carried out by a written questionnaire. The patients interviewed were both inpatient and patients arriving for outpatient consultation. The survey was conducted in June-November, 2020, with the oral consent of the respondents. 150 questionnaires were distributed, 144 questionnaires were returned, but 6 of them were incomplete. Return of questionnaires - 92 percent. Results. The study found that patients, with whom the optimal bowel stoma location was not discussed before surgery, were significantly more likely to have poor quality of life, it also turned out that as many as one-fifth of patients did not receive any information about the stoma and were not acquainted with the peculiarities of intestinal stoma care, and almost half of the respondents received this information after the stoma opera-tion. Conclusions. Preoperative patient training and collaboration are directly related to patients’ quality of life after bowel stoma formation surgery.

Cysto-Vaginoscopy of a 3D-Printed Cloaca Model: A Step toward Personalized Noninvasive Preoperative Assessment in Patients with Complex Anorectal Malformations

Introduction For the classification of the complexity of cloacal malformations and the decision on the operative approach, an exact anatomical assessment is mandatory. To benefit from using three-dimensional (3D)-printed models in preoperative planning and training, the practicability of these models should be guaranteed. The aim of this study was to evaluate the quality and feasibility of a real-size 3D-printed cloaca model for the purpose of cysto-vaginoscopic evaluation. Materials and Methods We performed a 3D reconstruction and printed a real-size, rubber-like 3D model of an infant pelvis with a cloacal malformation and asked invited pediatric surgeons and pediatric urologists to perform a cysto-vaginoscopy on the model and to complete a brief questionnaire to rate the quality and feasibility of the model and to indicate whether they would recommend the model for preoperative planning and training. Results Overall, 41 participants rated the model quality as good to very good (M = 3.28, standard deviation [SD] = 0.50, on a scale from 1 to 4). The model was rated as feasible for preoperative training (M = 4.10, SD = 0.75, on a scale from 1 to 5) and most participants (85.4%) would recommend the model for preoperative training. The cysto-vaginoscopy of the model was considered as a valid training tool for real-life cases and improved the confidence on the anatomy of a cloaca. Conclusion The results of our study indicate that patient-specific 3D-printed models might be a useful tool in the preoperative evaluation of complex anorectal malformations by simulation of cysto-vaginoscopy with an excellent view on anatomical structures to assess the whole spectrum of the individual cloacal malformation. Our model might be a valuable add-on tool for specialty training in pediatric colorectal surgery.

A META-ANALYSIS OF THE SOFT TISSUE DEFECTS CLASSIFICATION AND JUSTIFICATION OF THE OPTIMAL SURGICAL RECONSTRUCTION METHOD

During the military conflict in the East of Ukraine, considerable experience in providing medical assistance to wounded and injured with soft tissue defects has been accumulated. Taking into account the considerable diversity of defects of soft tissues on numerous a number of signs, which involves the application in the process of treatment of fundamentally different algorithms of preoperative training, planning of reconstructive intervention and method of surgical reconstruction there was a need to systematize the accumulated knowledge by developing the integral classification of soft tissue defects.

The beneficial effects of physical preoperative and postoperative training for the cognitive function in cardiosurgical patients

Background and aim The cardiac surgery patients have an increased risk of postoperative cognitive dysfunction (POCD). The positive healing effects of physical exercise was demonstrated early in patients with cognitive impairment. The aim of the study was to evaluate the effect of physical preoperative and postoperative training for the cognitive function in patients undergoing on-pump coronary artery bypass grafting (CABG). Methods We analyzed the neurophysiological data from 125 male coronary artery disease (CAD) patients who participated in two sub-studies: the patients with a short preoperative course of treadmill training (n=33) and with postoperative aerobic exercise training (n=92). The study of preoperative physical training included CABG-candidates, which were divided into 2 groups: with (n=17) and without training (n=16). The preoperative physical training consisted of a 5–7 day course of intensive training on a treadmill. The study with postoperative aerobic exercise training enrolled CAD patients, undergoing on-pump CABG, which were divided into 2 groups: with supervised cycling training (n=39) and without training (n=53). Three-week trainings course began on the 14-th day after CABG. The patients with and without preoperative and postoperative physical training were comparable in terms of preoperative characteristics and intraoperative parameters. The patients were underwent the neuropsychological and EEG examination to assess postoperative changes in neurophysiological performance. Results The patients with preoperative treadmill training had the POCD incidence at 7–10 days after GABG in 44% cases vs. 74% - in the group without training. The relative risk of POCD developing in the patients with preoperative training was: OR=0.24, 95% CI: 0.07–0.81, Z=2.297, p=0.02. Additionally, the patients with preoperative training demonstrated a lower power in the theta (4–6 Hz) and beta1 (13–20 Hz) frequency ranges 7–10 days after CABG. The patients with postoperative cycling training also demonstrated better cognitive function at 1 month after CABG compared to the patients without training. The incidence of POCD was 21% in the cycling training group vs. 44% – in the group without training. The relative risk of POCD developing was: OR=0.23, 95% CI: 0.09–0.60, Z=3.041, p=0.0024. Also, it was found that the postoperative cycling training group showed a lower percentage theta power increase at 1 month after CABG. Conclusion Both the short preoperative and three-week postoperative physical training course can produce beneficial effects on the postoperative neurophysiological status in CABG patients. The engagement of physical training in the rehabilitation program of CABG patients can improve cognitive functioning after cardiac surgery. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): RFBR and Kemerovskaya region

Preoperative training education with incentive spirometry may reduce postoperative pulmonary complications

Objective To assess whether preoperative incentive spirometer training would influence the development of postoperative pulmonary complications after lung resection. Methods Sixty-two lung resection patients were prospectively investigated; 17 were given an incentive spirometer preoperatively and 45 did not have an incentive spirometer preoperatively. Postoperatively, both arms exercised with an incentive spirometer. The number of repetitions per day, balls raised per repetition, correct technique of exercising, and postoperative pulmonary complications were compared between the 2 groups. Univariate binary logistic regression analysis of potential predictors of postoperative pulmonary complications led to multivariate analysis of independent predictors. Receiver operating characteristic analysis established the cutoff points of predictors. Results The group with no preoperative incentive spirometer developed more postoperative pulmonary complications than the preoperative incentive spirometer group (24.4% vs. 5.9%, respectively, p = 0.045). The preoperative incentive spirometer arm achieved more repetitions per day, balls per repetition, and correct incentive spirometer technique ( p = 0.002, p < 0.001, p = 0.034, respectively). Balls raised per repetition and repetitions per day postoperatively were identified as independent predictors of postoperative pulmonary complications ( p = 0.032 and p = 0.021, respectively). Less than 5 repetitions per day (sensitivity 93%, specificity 77%, p < 0.001) and less than 2 balls per repetition (sensitivity 93%, specificity 77%, p < 0.001) were predictive of postoperative pulmonary complications. Conclusion Preoperative incentive spirometer exposure ensured better compliance with postoperative treatment and a more accurate technique (balls raised per repetition, repetitions per day). These variables correlated with a lower postoperative pulmonary complication rate.

Study protocol of a single-arm pre-post study to assess the preliminary effectiveness and feasibility of a home-based bimodal prehabilitation program on preoperative aerobic fitness in high-risk patients scheduled for liver or pancreatic resection

<p class="abstract"><strong>Background:</strong> Controversial evidence currently exists regarding the feasibility and effectiveness to improve preoperative aerobic fitness during home-based prehabilitation in patients scheduled for liver or pancreatic resection, whereas morbidity rates are high following these resections. The primary aim of this study is to evaluate the preoperative oxygen uptake (VO₂) at the ventilatory anaerobic threshold before and after a four-week home-based preoperative training program with nutritional supplementation in high-risk patients scheduled for elective liver or pancreatic resection. Secondary aims are to evaluate program feasibility, immune system function, cardiopulmonary exercise test responses, individual progression profiles on training responses, quality of life, and postoperative course.</p><p class="abstract"><strong>Methods:</strong> In this multicenter study with a pretest-posttest design, patients with a liver or pancreatic tumor scheduled for elective resection will be recruited. To select the high-risk fraction of this surgical population, their VO₂ at the ventilatory anaerobic threshold should be &lt;11 ml/kg/min for final inclusion. A planned total of 24 high-risk patients will participate in a four-week (three sessions per week) home-based bimodal prehabilitation program. The partly supervised home-based preoperative training program consists of individualized goal setting followed by titration of interval and endurance training on an advanced cycle ergometer, combined with functional task exercises. Additionally, patients will be given protein and vitamin/mineral supplementation.</p><p class="abstract"><strong>Discussion: </strong>Effects of a partly supervised home-based bimodal prehabilitation regimen are unknown in high-risk patients opting for liver or pancreatic resection. Improved preoperative aerobic fitness might translate into improved postoperative outcomes and a reduced demand on care resources.</p><p class="abstract"><strong>Trial Registration:</strong> The study is registered in the Netherlands Trial Registry (NL6151) and was approved by the Institutional Ethics Committee, Twente, Enschede, the Netherlands (P17-08).</p>

Measures for the Development of Medical Additive Technologies in the Russian Federation

Three-dimensional printing has several significant advantages over traditional methods of production: simplification and acceleration of the production process, versatility, low cost and a few others. As a result, additive technologies have quickly become a highly promising area with great potential in many areas of human activity, finding more and more points of application. Medicine is no exception. The development of three-dimensional printing in the field of medicine can not only solve a few pressing health problems, but also stimulate the progress of technology. To date, three-dimensional medical printing is used in the following areas: individual prostheses both temporary and permanent wear, surgical instruments, simulation manuals for training medical students and preoperative training of surgeons. Of interest is the joint application of additive technologies with cellular technologies – bioprinting. Despite its great potential, this activity is not sufficiently regulated, which is a serious obstacle to its development. The introduction into practice of the principles proposed in this work of the device and functioning of a specialized service – laboratory of additive medical production – should solve this problem and contribute to the rapid development of medical three-dimensional printing in the Russian Federation.

Advantages and disadvantages of 3D printing for pre-operative planning of revision hip surgery

Total hip arthroplasty (THA) is one of the most successful and cost-effective interventions in medicine nowadays, providing reliable pain relief and functional improvement to those with osteoarthritis or inflammatory arthritis of the hip (P Kinov, B Antonov,’Possibilities for surgical treatment of acetabular osteolysis subsequent to revision arthroplasty of hip joint‘, Orthop Trauma. 52, 2015). Revision hip arthroplasty or severe reconstructive procedures in cases with significant anatomical defects require skilled surgical staff and accurate preoperative planning, including bone insufficiency, deficiency, discontinuity (anatomical assessment) as well as augmentation, cage or other requirements. (implant planning). Some authors recommend preoperative 3D model planning for precise anatomical assessment and preoperative training. This method has some limitations but could be successfully used in addition to conventional surgery.